David Sack M.D.

The Below-the-Radar Addict

Moving from one compulsion to another, this shape-shifter avoids detection.

There’s a popular misconception that people choose one drug, one compulsion, one vice and stick with it for life, or at least until they find their way into recovery. More commonly, people find what works at the time and then move onto the next thing. I call this lesser-known but equally troubled breed the “below-the-radar addict.”

Similar to the high-functioning addict, the below-the-radar addict has a problem that’s often overlooked by their friends, family and coworkers, but is a serious problem nonetheless. This is the person who jumps from compulsion to compulsion, getting one mildly under control only to act out in another way.

Take Ann, for example. She drank too much in her 20s but “outgrew” that habit, and then went on to binge-eat her way to a 40-pound weight gain. After trying a few fad diets, she decided the only way to lose weight quickly was to get a doctor to write a prescription for ADHDmedication.

Now, Ann has lost the weight, but because the stimulants interfere with her sleep she’s also taking sleeping pills regularly. Also, since losing weight, she’s obsessed with buying clothes and has gotten herself into quite a bit of debt outfitting her new figure. Just a few days without surfing the Web for a cute new this or that makes her feel antsy so she finds herself searching for something new to help her cope with the anxiety and emptiness she always seems to feel.

One compulsive behavior morphs into the next – a phenomenon sometimes called cross-addiction or addiction transfer – and the cycle continues because Ann isn’t addressing the underlying issues. She just moves from one coping mechanism to another, never realizing the true extent of her problem.

Addiction: The Ultimate Shapeshifter

In recent years, we’ve moved toward a view of addiction that encompasses not only drugs and alcohol but also compulsive behaviors such as gambling, eating, sex, work and spending. The American Society of Addiction Medicine defines addiction broadly to include “process addictions,” a view that is backed by research showing that certain pleasurable behaviors affect the same reward centers of the brain as drugs of abuse.

If your brain is wired for addiction, vigilance is required with every potentially addictive substance or behavior. Even if you’ve only struggled with alcohol in the past, other mood-altering substances (even certain over-the-counter medications or those prescribed by a doctor for a legitimate medical condition) could awaken the “sleeping tiger” of addiction. This is why, even years into recovery, alcoholics who “only” use marijuana or try to drink in moderation end up relapsing. It also helps to explain why you can spot a 12-Step meeting by the number of people chain smoking outside or downing pots of coffee.

Similarly, recovering addicts may find themselves in a chronic relapse cycle with no obvious trigger, only to discover later that sex and relationships are fueling their return to drugs. Or, like Ann, perhaps they turn to shopping or food or some other behavior that gives them a “high,” all the while celebrating their usually short-lived sobriety.

Ending the Addictive Cycle

Once you’ve struggled with one addiction, you are at greater risk of developing another. So is it ever possible to be free from addiction? Addiction can’t be cured, but like other chronic diseases, it can be successfully managed.

Those who understand the chronic nature of the disease are in the best position to recognize when addictive patterns resurface in cleverly disguised ways. Even if you’re in recovery, in good times and bad you’ll crave a familiar and dependable high, you’ll want to escape, but you have to make a conscious effort to manage loneliness, boredom and stress by drawing on the skills that helped you into recovery.

Addiction is more than a disease, it’s a lifestyle. Lasting change only happens when you address the core issues driving you to seek comfort or pleasure from a destructive source outside yourself. In some cases, the core issue may be an underlying mental health issue such as depression or anxiety that must be managed alongside the addiction (rather than treating each issue separately).

Whatever the cause, figuring out your triggers, monitoring your emotions and taking action at the first signs of addictive thinking or behavior are necessary to prevent cross-addiction and relapse. A social network of (sober) supporters, often in the form of friends, family, a therapist or a support group, can help you recognize budding problems and intervene if necessary.

Life “below the radar” can be fraught with difficulties. Others may think you have it all together. You may have even convinced yourself. But even if you think you’re not an addict, or you’ve found your way into recovery from one addiction, you’re not truly free if any mood-altering substance or compulsive behavior is impeding your life.

David Sack, M.D., is board certified in psychiatry, addiction psychiatry, and addiction medicine. As CEO of Elements Behavioral Health he oversees addiction treatment programs at Promises Treatment Centers in Malibu and West Los Angeles, The Ranch outside Nashville, The Recovery Place in Florida, and Texas drug rehabs Right Step and Spirit Lodge. You can follow Dr. Sack on Twitter @drdavidsack.

Dr. Sack, you pretty much wrote the story of my life. Started with hard drinking. Then women (while the hard drinking was going on). Cooled it on the booze and ladies, but then took up cigarettes for several years. Quit smoking, but then started drinking again. Moderately at first, then heavy before ending up in AA. Porn became a problem around this time. Haven't had a drink in several months, haven't smoked in years, don't watch very much porn anymore, but now have more interest in women again live women, not porn women).

I have been smoking crack for several years now . Been to rehab twice and want to go again . At the least i can go three days if i can not buy it there's always someone calling or nocking on my door . I no what i have to do but don't want to live life on lifes terms . I have been through a thing or two that i don't want to live life on lifes terms . I have been hiding out from the world . I have a problem with dealing with others , i am not good looking i can't seem to trust anyone or anything . I almost ready to quite life all together . I believe in god , and i know he has things he wants of me . I find it hard to trust even him . Please help me to find the light.

I have been smoking crack for several years now . Been to rehab twice and want to go again . At the least i can go three days if i can not buy it there's always someone calling or nocking on my door . I no what i have to do but don't want to live life on lifes terms . I have been through a thing or two that i don't want to live life on lifes terms . I have been hiding out from the world . I have a problem with dealing with others , i am not good looking i can't seem to trust anyone or anything . I almost ready to quite life all together . I believe in god , and i know he has things he wants of me . I find it hard to trust even him . Please help me to find the light.